317:35-17-18. ADvantage services during hospitalization or NF placement

317:35-17-18. ADvantage services during hospitalization or NF placement

[Revised 09-01-24]

When the member's OKDHS social worker, ADvantage case manager, or the ADvantage Administration (AA) is informed by the member, family, or service provider of a member's hospitalization or placement in a nursing facility (NF), that party determines the date of the member's institutionalization and communicates the date, name of the institution, reason for placement, and expected duration for placement to the other ADvantage Program Administrative partners. When a member requires hospital or NF services, the case manager assists the member to access institutional care, periodically monitors the member's progress during the institutional stay, and, as appropriate, updates the person-centered service plan and prepares services to start on the date the member is discharged from the institution and returns home. All case management units for institution transition services to plan for and coordinate service delivery and to assist the member to safely return home, even when provided while the person is in an institution, are considered delivered on and billed for the date the member returns home from institutional care.

(1) Hospital discharge. When the member returns home from a hospital or when notified of the member's anticipated discharge date, the case manager notifies relevant providers and the AA and coordinates the resumption of services.

(2) Nursing Facility placement of less than 30-calendar days. When the member returns home from a NF stay of 30-calendar days or less or when notified of the member's anticipated discharge date, the case manager notifies relevant providers, the member's OKDHS worker and the AA of the discharge and coordinates the resumption of ADvantage services in the home.

(3) Nursing Facility placement longer than 30-calendar days. When the member is scheduled to be discharged and return home from a NF stay that is longer than 30-calendar days, the member's OKDHS worker, ADvantage case manager, or the AA, whoever first receives notification of the discharge, notifies other ADvantage Program Administrative partners to expedite the restart of ADvantage services for the member. The member's case manager provides institution transition case management services to assist the member to re-establish himself or herself safely in the home. Individuals residing in a NF may be referred to OHCA Living Choice for assistance transitioning to the community, as needed.

Disclaimer. The OHCA rules found on this Web site are unofficial. The official rules are published by the Oklahoma Secretary of State Office of Administrative Rules as Title 317 of the Oklahoma Administrative Code. To order an official copy of these rules, contact the Office of Administrative Rules at (405) 521-4911.